Postmortem changes -Immediate

Postmortem changes -Immediate


Postmortem changes after death

  1. Immediate Changes
  2. Early Changes
  3. Late Changes

Immediate changes

  1. Permanent cessation of Brain function
  2. Complete Cessation of Circulatory function
  3. Entire and permanent cessation of Respiratory function

Permanent Cessation of Brain Function: 

  • Loss of Sensations; viz, 
  • touch, pain and temperature
  • Loss of reflexes
  • Unresponsiveness
  • Flat E.E.G.Rhythem
  • Confirmation of Brain- stem death

Brain –stem death: 

  • Brainstem death is defined by the absence of all brainstem mediated cranial nerve reflexes.

Criteria for Brain Death/Brainstem death 

  • The patient must be comatose state at least six hours.
  • No Abnormal Decorticate or decerebrate postures should be present
  • Absent Pupillary Light reflex (CN II, III)
  • Dilated fixed pupil not responding to light surest sign of brain stem death
  • Pupils are usually midsized but may be enlarged but they should not be small
  • Absent Corneal Reflex (CN V, VII)
  • Absent Vestibulocochlear Reflex (CN III, IV, VI, VIII) (No eye movement in response to caloric irrigation of ears)
  • Absent Oculocephalic Reflex
  • Absent Doll’s eye reflex
  •  Eyes will move with the head
  • No occular movements on rapid turning of head.
  • Absent Gag Reflex (CN IX, X)
  • Absent Tracheal Cough Reflex (CNX)
  • Absent Central Motor Response to Pain (CN V, VII) (No response to deep somatic stimulation).
  • A positive apnea test(apnea despite induced hypercapnia)

After disconnection of ventilator.

  • Complete Cessation of Circulatory Function 
  1. Magnus’s test:Fingers fail to show congestion and swelling to a ligature applied at their base.
  2. Finger nail test:blanching and filling of blood on applying pressure and release of pressure.
  3. Diaphanous test(transilluminationtest):Fallure to show redness in finger web spaces on transillumination from behind.
  4. Icard’s Fluorescein test:Failure to produce yellowish green discoloration of skin on injection of fluorescrin dye.
  5. Heat test
  6. Artery incision test
  7. A flat E.C.G. for a continuous period of five minutes

 Entire and permanent cessation of respiratory function 

  1. Mirror test:Mirror held in front of nose does not show vapors and blurring
  2. Feather test:No movement of feather if held in front of nose.
  3. Winslow’s glass water test.
Suspended Animation
  • It is a condition in which the vital functions of the body are at such a low level that they cannot be appreciated by clinical examination 

Apparent death 

  • This may last few seconds to minutes.

Voluntary- 

  • by yogis 

Involuntary –

  •  drowning, electrocution, heat stroke, typhoid fever etc. 
Exam Question
 

Criteria for Brain Death/Brainstem death  

  • Absent Pupillary Light reflex (CN II, III)
  • Dilated fixed pupil not responding to light surest sign of brain stem death
  • Absent Central Motor Response to Pain (CN V, VII) (No response to deep somatic stimulation).
  • A positive apnea test

After disconnection of ventilator.

  • Complete Cessation of Circulatory Function 
  • Magnus’s test:Fingers fail to show congestion and swelling to a ligature applied at their base.
  • Finger nail test:blanching and filling of blood on applying pressure and release of pressure.
  • Diaphanous test(transilluminationtest):Fallure to show redness in finger web spaces on transillumination from behind.
  • Icard’s Fluorescein test:Failure to produce yellowish green discoloration of skin on injection of fluorescrin dye.

 Entire and permanent cessation of respiratory function 

  • Mirror test:Mirror held in front of nose does not show vapors and blurring
Suspended Animation
  • It is a condition in which the vital functions of the body are at such a low level that they cannot be appreciated by clinical examination 

Apparent death 

  • This may last few seconds to minutes.
  • Voluntary- by yogis 
  • Involuntary – drowning, electrocution, heat stroke, typhoid fever etc. 
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